MedicaidCoverageHigh impact
Oregon Health Plan coverage of telemedicine services
Oregon Health Plan·OR·Plan
Effective date
Mar 13, 2020
We identified it
Aug 19, 2026
Summary
Oregon Health Plan (Medicaid) is expanding telemedicine/telehealth coverage effective March 13, 2020, to include synchronous audio/video services, telephone visits, online patient portal services, and provider-to-provider consultations for both physical and behavioral health providers. New CPT codes are now billable for telephone services by behavioral health providers, and fee-for-service Medicaid claims system changes are pending with up to one week for MMIS configuration.
Action Required
By March 27, 2020 (one week after March 20 publication date, allowing for MMIS configuration): (1) Billing team must update Oregon Health Plan member encounter forms and billing software to enable billing of newly covered telemedicine codes (99441-99443 for physicians/QHPs, 98966-98968 for behavioral health providers, 99421-99423 and 98970-98972 for online services, and 99201-99215 for audio/video synchronous visits). (2) Providers must be trained that telemedicine services under Guideline Note A5 are now covered for both physical and behavioral health, including synchronous video, telephone, online patient portal, and provider-to-provider consultations. (3) Behavioral health providers must note that telephone service codes (98966-98968, 99441-99443) are NEW and only payable when: call is patient-initiated (includes return call requests), NOT related to an assessment/management service within prior 7 days, and NOT related to a scheduled appointment within next 24 hours or soonest available. (4) Verify that online communications use encrypted/HIPAA-compliant platforms. (5) For CCO members, contact individual CCOs for their specific telemedicine coverage policies, as they may differ from fee-for-service guidance. (6) Monitor for published updates to OAR 410-130-0610, 410-146-0085, and 410-147-0120 rules. Failure to update billing processes will result in claim denials and missed revenue opportunities for eligible telemedicine visits.